MEDICARE: SHELLY HUMMEL LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	861	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141G8	OTHER	NC	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1225186711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY HUMMEL LMFT

Provider Business Mailing Address
First Line	:	1009 BINKLEY CHAPEL CT
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4244
Country	:	US
Telephone Number	:	919-880-2566
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 S WHITE ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2781
Country	:	US
Telephone Number	:	919-880-2566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/20/2009

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Directions to “ SHELLY HUMMEL LMFT” Practice Location

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